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Driving Improvement

News and presentations from today’s conference focusing on learning from NHS Trusts that have driven and demonstrated improvement, and understand what works to turn around culture and practice. 

Driving improvement in culture and leadership
Dr David Evans, Chief Executive Northumbria NHS Foundation Trust
Northumbria NHS Foundation Trust was rated outstanding by the CQC, Sir Mike Richards Chief Inspector of Hospitals stated that “We found Northumbria NHS Foundation Trust to be one of the best hospital trusts in England.” 

Dr Evans  covered the following in his presentation:
• learning from embedded practice at Northumbria 
• developing the culture of the organization 
• models for improvement 
• engaging staff and demonstrating change 
• our experience

Dr Evans commented: 

"Everything is changing – what worked in the past will not work in the future....Nobody’s perfect but CQC are looking for evidence of embedded practice, awareness of recognition of issues and plans to address them, evidence of ‘the controlling mind’."

"The CQC are now less ‘mob handed’ than before....This will represent a significant change in relationship which will look at closer joint working, shared data, an open and honest culture.  A move towards journey of improvement.  CQC link officers, will attend governance meetings."

Dr Evan discussed CQC reporting including local data quality, local governance systems, local responses (how do you respond to slippages, issues etc), local accountabilities (how do you hold all services accountable, clearly identifiable chain of accountability).

The CQC is planing 4 central tenets, two aimed at public and two at organisations:

  1. Securing trust and confidence form public – ratings model
  2. Organisations encouraged to deliver quality improvement and efficiency
  3. Improve use of data and info – risk based approach
  4. Implementing single shared view of quality – establish common framework for quality measurement…to highlight initiatives directly to the regulator.  Unequivocal about advantages to be gained ifeveryone in the system looked at quality the same way.  This will not replace inspection and enforcement.


Dr Evans said the aim must be for consistency of quality, safety and effectiveness across all sectors, less division between different healthcare sectors, don’t blame ‘other’ areas for failures, it's a common interest to improve.  On clinical leadership he said Trusts must have clear structures and accountabilities, a leadership development programme (focused on safety), speed and clarity of response (don’t sit on problems), sharing of learning (system for disseminating in place – joined up systems), open outlook and attitudes (use of multiple sources).

“Staff engagement trumps all other measures for predicting the quality of organizational outcomes”

Full PowerPoint presentation


Tackling variation in quality on the wards
Chris Pearson,
Director of Nursing, East Lancashire NHS Foundation Trust

Pre-Conference abstract: East Lancashire Hospitals NHS Trust went into special measures in July 2013, following a review by Sir Bruce Keogh. In May 2014, a CQC inspection found that the Trust has made enough progress to come out of special measures and rated the Trust as requires improvement. A focused inspection in 2015 and a Well Led Review in September 2016, the Trust was rated GOOD overall. 

Addressing variation in quality on the wards was an area of focus during this time and this brought the introduction and implementation of the Nursing Assessment and Performance Framework. A tool for assessing care that promotes the four aspects of safety, communication, accountability, multidisciplinary team working and leadership. The assessment is based on the CQC 5 Key Lines of Enquiry. The assessments are carried out using a team approach which is unannounced. A rating is given to each ward following assessment and actions are taken. Assessments are repeated based upon the outcome. 
Getting the culture right was key and at the start there was a culture of not wanting to measure things, not wanting to monitor things and not wanting to report things because staff didn’t feel comfortable to do so. A focus on developing a culture for staff to stand up and speak out was developed. 
The Trust is committed to continuing with the quality improvement work and is aiming for an OUTSTANDING rating. 

Notes from Chris' presentation:

It's a battle for hearts and minds – you have to take people with you or you won’t succeed. The trust is in top 20% for staff engagement, top 100 NHS employers.

The nursing assessment performance framework is a tool for assessing ward care.  It promotes 4 aspects of safety – communication, accountability, multidisciplinary team working, and offers a reliable method to understand variability in care, gives overall picture.

Benefits – culture of safety, ensures patients at centre, provides open communication re patient safety, ensures local accountability for outcomes/improvements, improves multi-disciplinary teamwork.

Assesments are undertaken by a team of 5.  Unannounced, inspection style.  Observations of care, meal delivery, discuss with patients, relatives, staff, ward managers, review overall ward performance, review of relevant documents, review of the environment.

Leadership is the lynchpin to make improvement happen.

When you are being inspected – know your own story – much better to tell CQC what you are doing to improve than just let them discover areas which need improvement.

Started at ward level – but involve the whole team, including consultants as it is a team effort.

Full PowerPoint presentation
 

Future events of interest:

Masterclass: The Duty of Candour in Practice
Thursday 23 November 2017 
De Vere West One Conference Centre, London

Clinical Audit Masterclass
Monday 27 November 2017 
De Vere West One Conference Centre, London

Root Cause Analysis: 1 Day Intensive Training Course
Thursday 7 December 2017 
Manchester Conference Centre, Manchester

National PROMs Summit 2017
Monday 11 December 2017 
De Vere West One, London

National NICE Quality Standard for Chronic Kidney Disease in Adults
Friday 19 January 2018 
De Vere West One Conference Centre, London

Sepsis Summit: Implementing the New National Quality Standard
Monday 22 January 2018 
De Vere West One Conference Centre, London

Effective Discharge Planning and Practice
Monday 22 January 2018 
De Vere West One Conference Centre, London

Masterclass: Creating Caring Cultures: Getting Started
Monday 22 January 2018 
De Vere West One Conference Centre, London

Root Cause Analysis: 2 Day Intensive Training Course
Tuesday 23 January 2018 — Wednesday 24 January 
De Vere West One Conference Centre, London

Effective Clinical Director
Monday 29 January 2018 
De Vere West One Conference Centre, London

Clinical Audit for Improvement in Mental Health
Friday 9 February 2018 
De Vere West One Conference Centre, London

Patient Experience Insight Summit
Thursday 22 February 2018 
The Studio Conference Centre, Birmingham

Transforming Outpatient Services National Summit
Monday 26 February 2018 
De Vere West One Conference Centre, London

Clinical Audit Summit 2018: Clinical Audit for Improvement
Monday 5 March 2018 
De Vere West One Conference Centre, London

Masterclass: Human Factors Principles + Improvement Science = Better Outcomes
Friday 23 March 2018 
De Vere West One Conference Centre, London

Root Cause Analysis: 2 Day Intensive Training Course
Wednesday 25 April 2018 — Thursday 26 April 
De Vere West One Conference Centre, London

Root Cause Analysis: 2 Day Intensive Training Course
Tuesday 22 May 2018 — Wednesday 23 May 
De Vere West One Conference Centre, London

Masterclass: The Duty of Candour in Practice
Thursday 24 May 2018 
De Vere West One Conference Centre, London

Masterclass: The Use of Restrictive Interventions: The legal framework
Tuesday 17 July 2018 
De Vere West One Conference Centre, London

 

 

 


 


24 November 2017

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